**4.3 Panic disorder**

*Anxiety Disorders - The New Achievements*

• Agoraphobia,

• Specific Phobia,

• Social anxiety disorder,

anxiety disorders [12].

**4.1 Separation anxiety disorder**

seen equally in boys and girls.

• Generalized anxiety disorder,

• Other unspecified anxiety disorder,

• Anxiety disorder related to another medical condition,

• Anxiety disorder caused by substance or medication,

• Anxiety disorders caused by substances and medication are unspecified

Separation anxiety disorder can be defined as experiencing fear and anxiety that is more than expected and repetitive in terms of developmental level resulting from separation from home or someone the person is attached to for at least four weeks in children, and for at least six months or longer in adults. It is seen that individuals with separation anxiety disorder do not want to go to school or elsewhere because of the fear of separation. The main feature of separation anxiety disorder is excessive anxiety caused by leaving the mother, father, home or familiar environment. It is

*Etiology:* According to the psychodynamic approach, children who are attached ambivalently are very busy with the care of their caregivers, which reduces their exploration behaviors of their environment and thus causes separation anxiety to develop. Stressful events such as parental divorce, illness, loss are important risk factors for separation anxiety disorder. In a study, it was found that the depressive, cyclothymic, irritable and anxious temperament scores of the mothers of children

Symptoms in separation anxiety disorder differ according to the developmental period. In children aged 5-8 years, the fear of a bad event and rejection of school, intense distress during separation at the age of 9-12, school refusal in adolescents

*Comorbidity:* Frequently, depression, bipolar disorder, hyperactivity disorder,

*Treatment:* In the treatment of separation anxiety disorder, the most important point is planning to include the family, school and child. Cognitive therapy is one of the effective methods. Antidepressants, selective serotonin reuptake inhibitors, are used in drug therapy. One study suggested that vilazodone can be used in the

The most important feature of this disorder is that although the individual can speak in other situations, s/he constantly does not speak in certain specific social situations (when s/he meets people s/he does not know, etc.) where s/he is expected to speak. The disorder must last at least one month and affect the person's education, work success, and social life. It usually occurs in the preschool period.

with separation anxiety disorder were higher than the control group [13].

aged 13-16, and physical complaints appear as symptoms.

treatment of separation anxiety disorder [14].

**4.2 Selective Mutism**

personality disorders and other anxiety disorders are seen together.

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In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) [American Psychiatric Association (APA)] it is stated that at least four of the following symptoms must be present to determine the presence of a panic attack. These are:


Panic disorder, which is a very old disease, is a syndrome characterized by sudden and extreme anxiety with unreasonable and unpredictable panic attacks. Its most important feature is that it is accompanied by intense physical discomfort. Panic attacks can occur only once, or frequently, on a weekly, monthly or even annual basis. Panic attack disorder is usually seen in the 20s. The panic attack is an unreasonable and severe state of anxiety. During panic attacks, symptoms such

as palpitations, accelerated heart rate, sweating, trembling/shaking, shortness of breath, feeling of choking, breathlessness, chest pain, fainting, fear of losing control or going crazy, numbness, tingling, chills or hot flushes can be seen.

The presence of a medical drum that may cause anxiety should first be investigated in a patient presenting with panic attack. All the drugs used by the individual should be questioned, and the side effects of the drugs should be considered. Below are some medical conditions that cause symptoms similar to panic attacks.

**Certain medical conditions that produce symptoms similar to panic attacks**


The majority of patients have challenging life events before the first panic attack occurs. Low socio-economic level, delay in treatment, presence of additional diagnoses cause a negative course in panic disorder.

Comorbidity: Depression is seen with social phobia, specific phobia, traumatic stress disorder and alcoholism.

Treatment: Specific serotonin reuptake inhibitors should be the first choice in the treatment of panic disorder. If the patient does not respond to treatment, switching to other specific serotonin reuptake inhibitors is recommended. If there is no response to two specific serotonin reuptake inhibitors and there is severe tolerance, it is recommended to switch to SNRI. Alprazolan is also highly effective. Drug treatment should last at least a year. Behavioral-cognitive psychotherapy is an effective method in panic disorder. This method attempts to change the patient's perception of physical symptoms. It will be useful to teach breathing exercises to the patient [15].

#### **4.4 Agoraphobia**

Agoraphobia, which is shortly defined as the fear of open space, is the fear of being deprived of help or being in places where it is difficult to escape.

*Treatment:* Combination of pharmacotherapy and psychotherapy (behavioral, cognitive, virtual therapies) is recommended in its treatment. Benzodiazepines, SSRIs, tricyclic and tetracyclicantidepressants are recommended as diocological [15].

#### **4.5 Social phobia (social anxiety disorder)**

It is a disorder characterized by blushing, sweating, and trembling of the hands when one believes that s/he is perceived negatively by others while sitting or talking in public. The individual is afraid of social or performance situations where embarrassment can occur and firmly believes that s/he will be subject to possible reproach by others [12]. The onset of the symptoms of this disorder often occurs in

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**Table 1.**

*Specific classification of simple phobias.*

*Anxiety Disorders*

distress.

cases [15].

**4.6 Specific phobia**

**4.7 Generalized anxiety disorder**

starts in childhood and adolescence [2].

*DOI: http://dx.doi.org/10.5772/intechopen.93952*

late childhood or early adolescence and becomes chronic and sometimes continues throughout life. It is equally prevalent in males and females (Puri & Treasaden, 2011). The disorder affects social or occupational functionality or causes significant

*Treatment:* In its treatment, the combination of psychotherapy and pharmacotherapy has an advantage over the individual application of both treatments. The drug groups to be used in the treatment of social phobia similar to other anxiety disorders are SSRIs, benzodiazepines, venlafaxine and busprone. MAO inhibitors such as phenelzine and moclobemide have been shown to be successful in severe

It is an excessive, illogical and meaningless fear of a specific object (snake, dog, etc.) or a situation (injection, darkness, etc.). Exposure to phobic stimulus produces compelling panic symptoms, including palpitations, sweating, dizziness and difficulty in breathing. Phobias can begin at any age. People can be phobic towards almost any object or situation. Those that start in childhood often disappear without treatment. But those that start in adulthood or are persistent often require therapeutic support. The disorder is diagnosed more often in females than in males

[16]. The specific classification of simple phobias is given in **Table 1**.

*Treatment:* It is not enough to use drugs alone in the treatment of specific phobias. Behavioral therapy, insight-oriented therapy, virtual therapy and pharmacotherapy are at the forefront in its treatment [17]. The main principle of treatment should be exposure to the feared situation. When the phobia is accompanied by panic attacks, beta-adrenergic receptor antagonists or benzodiazepines can be used. The combined use of pharmacotherapy and psychotherapy may also be effective.

It is an anxiety disorder characterized by being chronic and unrealistic, and extreme anxiety that must last at least 6 months. Symptoms can cause distress to the person in social, professional and other important areas. Individuals with this disorder are constantly worried. Restlessness, excessive excitement, fatigue, sleep disturbance and muscle tension are significant symptoms. Anxiety often results in difficulty in making self-decisions, and the person seeks constant approval from those around him. They always feel like they are going to get bad news. It usually

*Treatment:* Cognitive-behavioral, supportive and insight oriented therapy and pharmacotherapy have a role in its treatment. The main drug groups used in the

*Comorbidity:* It is seen with depression and other anxiety disorders.

**Clinical name Feared object or situation**

Acrophobia Heights Agoraphobia Open spaces Claustrophobia Closed spaces Hematophobia Blood Zoophobia Animals

#### *Anxiety Disorders DOI: http://dx.doi.org/10.5772/intechopen.93952*

late childhood or early adolescence and becomes chronic and sometimes continues throughout life. It is equally prevalent in males and females (Puri & Treasaden, 2011). The disorder affects social or occupational functionality or causes significant distress.

*Treatment:* In its treatment, the combination of psychotherapy and pharmacotherapy has an advantage over the individual application of both treatments. The drug groups to be used in the treatment of social phobia similar to other anxiety disorders are SSRIs, benzodiazepines, venlafaxine and busprone. MAO inhibitors such as phenelzine and moclobemide have been shown to be successful in severe cases [15].
